# Evaluating the need for Epstein-Barr virus DNAemia monitoring in liver transplant recipients in India

## TL;DR

This study examines how common Epstein-Barr virus (EBV) DNAemia is in liver transplant recipients in India and its link to post-transplant complications.

## Contribution

The study provides insights into EBV DNAemia prevalence and risk factors in liver transplant recipients in India, where data is limited.

## Key findings

- EBV DNAemia was detected in 19.5% of liver transplant recipients, with higher prevalence in children.
- Age and pre-transplant EBV serostatus were significant predictors of EBV DNAemia.
- Three cases of PTLD were observed, emphasizing the need for monitoring EBV DNAemia in both adults and children.

## Abstract

Epstein-Barr virus (EBV) DNAemia poses a significant risk to transplant recipients, leading to Post-transplant lymphoproliferative disorder (PTLD). This study aims to determine the occurrence of EBV DNAemia among liver transplant (LT) recipients and analyze its association with various clinical parameters. Retrospective data search on 801 patients who underwent LT from January 2015 to December 2024 was performed. Of these, 257 recipients with available EBV DNA test records post-transplant were included and divided into EBV DNAemia and non-EBV DNAemia group. Various pre-transplant (age, MELD/PELD score, transplant type, EBV/CMV serostatus), transplant (cold/warm ischemia time, blood transfused), and post-transplant factors (EBV DNAemia, CMV infection, rejection, and immunosuppressant) were compared in both groups using univariate and multivariate analysis. Out of 257 cases, 138 (53.7%) were adults with a median age of 29 (IQR: 4.5–47) years. EBV DNAemia group included 50 (19.5%) cases with median age 2 (IQR: 1–5) years, majority (56%) classified as high-risk. The median time of EBV DNAemia detection since LT was 319 (IQR: 190–732) days with median viral load of 3.33 (IQR: 2.85–3.80) log10 copies/mL. PTLD developed in three cases (both high/intermediate risk). Non-EBV DNAemia group included 207 (80.5%) cases, with median age of 36 (IQR: 11–49) years, primarily belonging to intermediate risk. Age and pre-transplant EBV serostatus were found to be associated with EBV DNAemia on multivariate analysis. Routine monitoring of EBV DNAemia in both adult and pediatric LT recipients, regardless of pre-transplant serostatus, is crucial for early detection and management of EBV DNAemia/associated complications.

There is a significant lack of comprehensive studies on the prevalence and clinical impact of EBV DNAemia among liver transplant (LT) recipients in India. The absence of standardized monitoring and management protocols across Indian transplant centers further adds to inconsistencies in clinical practices, leading to challenges in early detection and intervention. Existing research primarily focuses on the high-risk pediatric renal transplant recipients with limited data available for adult LT recipients. This study aims to address these gaps by providing crucial insights into EBV DNAemia among Indian LT recipients and its association with various clinical parameters.